Provider Demographics
NPI:1821200783
Name:AMERICAN STAR HOME 1 ICF/DD-N
Entity Type:Organization
Organization Name:AMERICAN STAR HOME 1 ICF/DD-N
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:925-813-1979
Mailing Address - Street 1:2009 FITZGERALD WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513
Mailing Address - Country:US
Mailing Address - Phone:925-813-1979
Mailing Address - Fax:925-420-6748
Practice Address - Street 1:1209 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-548-1903
Practice Address - Fax:650-548-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000351315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities